Electronic Health Records, reimbursement,

Electronic Health Records, reimbursement,

What is the relationship between Electronic Health Records, reimbursement, HIPAA, and EDI transactions?
First let’s give definitions for all of these. From the beginning you already know what EDI transactions are. Electronic Health Records (EHR) are an electronic version of a patient’s chart. EHRs are there to make the information available instantly to authorized users such as doctors and nurses. HIPPA was explained in the last page. Reimbursement means that it is a method of payment for medical treatment or hospital costs. This is usually done by a third party.

So now that has been explained I am going to tell you the relationship between all of these. First when you go to the doctor all of your patient information is now in a database and what comes up on a computer screen is your Electronic Health Record. This information contains everything from what you were there for that day, to any prescriptions that you are taking. It can also include any radiology reports that you might have needed in the past. Because of HIPPA these records are safe and secure. Also now because of HIPPA we have EDI transactions. Specifically, EDI claim transactions.

Now if you get a “bill” in the mail from your insurance provider with a list of items that you have to pay for or what your insurance has paid for. While you are looking through this “bill”, you may see an item or two that you know is supposed to be covered by your insurance. That is where the EDI claim transactions come into play. You get a hold of your insurance provider and they then file an electronic claim submission. This is now a faster, and easier way to submit claims. Because of your claim being filed this way, if the insurance provider agrees that they should have paid for a service, then you will be reimbursed for that service.

Example of HIPPA/EDI Claim Transaction

(Brown, Kelly, & Querusio, 2011)

References
Admin. (2015, July 20). The benefits of using EDI in your organization . Retrieved from Expert Fortran – Latest Information about Software and PC Programs: http://www.expertfortran.com/the-benefits-of-using-edi-in-your-organization

Brown, P., Kelly, J., & Querusio, D. (2011, May/June). Toward a Healthcare Business-Process Reference Model. IT Professional, 13(3), pp. 38-47. doi:doi:10.1109/MITP.2010.65

HIPPA. (2009). Retrieved from National Info: http://www.nationalinfo.com/hippa.asp

Kavidayal, S. (2015, July 07). Electronic Data Interchange in Healthcare. Retrieved from Linkedin: https://www.linkedin.com/pulse/electronic-data-interchange-healthcare-swati-kavidayal

Villanueva, J. C. (2013, September 03). Securing HIPAA EDI Transactions with AS2. Retrieved from JScape: http://www.jscape.com/blog/bid/101188/Securing-HIPAA-EDI-Transactions-with-AS2

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